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    • The evaluation of common causes of SD in middle age

    2018-11-13

    The evaluation of common causes of SD in middle age women has shown that the primary disorders called wst-1 syndrome and restless leg syndrome are common in this population [8]. By means of laboratory tests was observed that the 53% of women presented apnea syndrome and restless leg syndrome or both in a study carried out in climacteric women that were experiencing lack of sleep [46,47]. The best predictors to detect objectively the poor quality of sleep were apnea, restless leg syndrome and awakenings at night. The best predictors to detect subjectively the poor quality of sleep with PSQI were detected as the presence of anxiety and hot flashes at the first half of the night. The adequate management of hot flashes have been proved to improve some manifestations related to lack of sleep; even so, it does not influence in some primary sleep disorders. On the other hand, SD could be associated with higher morbidity and mortality in significant magnitudes. For that reason, is necessary to pay careful attention, as well as to increase the sensibility of the specialist in SD cases and its implications in health women [8]. The Epworth Sleepiness Scale (ESS) allows identifying specifically the daytime somnolence, which also has demonstrated to be a risk factor in the worsening of quality of life during menopause. This scale is easy to apply and allow establishing aspects related to the impact of the sleep disorder in the next day. Additionally, it is very helpful to identify modifications in the quality of life in women as consequence of SD presence; the aforementioned impact has been considered essential and important [9]. The ESS was the only one identified to determine the pathological daytime somnolence; it helps to precise the impact of sleep in daily rest conditions carry out by women [30,31]. It should always explore aspects related to quality of sleep and the specialist must consider questions that allow identifying SD when climacteric women are evaluated. The identified scales have validity and are good tools to identify subjectively SD and to measure the quality of sleep. It should be noted that sleep absence is not only caused by menopause or hot flashes. The common perception of sleep absence is associated with the ovarian hormonal reduction around the age of menopause, in some women the baseline before menopause has worsened with the elderly [12].
    Conclusion
    Conflict of interest
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    Acknowledgments
    Introduction Insomnia is a common sleep disorder in general population with the reported rate of 10–25% of adults in most countries [1], while the rate may be differed according to assessment measures. For example, based on Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), and Polysomnography criteria the rate of 15, and 35% were reported respectively [2]. It is predominantly defined by subjective reports of difficulty in initiating and maintaining sleep, leading to a lack of restorative sleep [3]. Insomnia is considered as a pervasive disorder with a chronic course that can affect quality of life negatively [4]. A considerable degree of morbidity and even a degree of mortality have been reported in patients with insomnia [5]. The daytime consequences of insomnia have been the focus of several studies. Self-reports of fatigue; sleepiness; irritable and depressed mood; limited ability to enjoy being with friends; cognitive impairments such as trouble in remembering, confused thinking and judgment, and difficulties of concentration; and work absenteeism are among the common findings of these studies [6–15]. There is also a positive correlation between the consequences and the reported severity of insomnia. However, there is evidence to support the idea that patients\' perception of quality of sleep, or subjective meaning of sleep is associated with self-report of their daily function impairment. Accordingly, patients with an objective bad night\'s sleep and subjective report of a bad night\'s sleep have daily complaints [15]. On the other hand, a greater propensity to underestimate total sleep time and overestimate time spent awake has been reported in patients with insomnia [16,17]. In fact, patients\' experience of insomnia and their perception may have an important role in the reporting of insomnia and daily function Therefore, understanding of the subjective experience is necessary. However, the experience may be difficult to measure objectively [18].